RSS Feedhttps://10.40.239.128/blogs/rss-feed/Blog RSS Feeden{BA509D5F-3A98-4FCB-B852-6731CFA45462}https://10.40.239.128/blogs/2014/04/guide-to-choosing-heart-healthy-snacks/Guide to Choosing Heart-healthy Snacks<p>Snacks should be around 100-200 calories &ndash; enough to give us a little energy boost, but not too much that it will work against our health goals. You also don't want the snack to be so large that it ends up being equivalent to a full meal. The idea of a snack is to help tide you over, so stick to that 100-200 calorie snack.</p>
<p>Snacks ideally have a little bit of carbohydrate (whole grains, fruits/vegetables, or milk &amp; yogurt) and some protein.</p>
<p>They can be a great opportunity to meet our fruits and vegetable needs, too. Here are some examples of snacks you can try:</p>
<div>
<p>&nbsp;- Veggies + hummus<br />
&nbsp;- Apple + string cheese<br />
&nbsp;- Plain nonfat yogurt + berries<br />
&nbsp;- Cucumbers + cottage cheese</p>
<p>Almonds are also one of the snacks I recommended during the webcast. Go with unsalted, and have a little bag of them in your purse or desk at work. If you start to get the munchies, reach for some of those instead of the chocolate or candies that are often found around the office.</p>
<p><a href="http://intermountainhealthcare.org/hospitals/imed/communityresources/tv/Pages/archives.aspx" target="_blank">Check out the webcast</a> so you can get all the information about healthier shopping (and eating). It will be available in the archives shortly, so if you don't see it immediately, check back in a few days.&nbsp;</p>
</div>Thu, 10 Apr 2014 00:00:00 -0600{CE206EDB-4F66-4F79-AD42-E835E367601E}https://10.40.239.128/blogs/2014/04/interval-training-will-improve-heart-health/Interval Training will Improve Heart Health<p>Interval training is simple - implement short bursts of more intense cardio exercise during your routine workout. Here's one example of what you can do on a treadmill to implement interval training, but you can also watch the short video below as I explain and demonstrate each of these elements.&nbsp;</p>
<p>1 - Start walking on the treadmill at a pace that you feel you can maintain throughout your workout. You should be able to talk without sounding out of breath, but singing may not be doable.&nbsp;</p>
<p>2 - After a 3-5 minute warmup, increase the speed of the treadmill (or increase its incline) to push yourself a little harder for 30 seconds. After 30 seconds, return the treadmill speed and incline to your starting position and go for two or three minutes.&nbsp;</p>
<p>3 - During your recovery period (which is that 2-3 minute break from the more intense elements of your workout) your heart rate will gradually slow down to roughly the same level you were at before your burst.&nbsp;</p>
<p>4 - After your recovery period, go for another 30-second burst of intensity, then return back to your initial treadmill settings.&nbsp;</p>
<p>5 - Continue implementing those short bursts of increased exercise throughout your 15-20 minute workout.&nbsp;</p>
<p>6 - Once you have completed your final burst and recovery period, slow the treadmill down gradually over the next few minutes to help your body cool down. NOTE: The warm-up and cool-down periods are very important for your body during a workout, so don't skip them - you're body will remind you later that you missed them.&nbsp;</p>
<iframe width="853" height="480" src="//www.youtube.com/embed/gUr5I3OImLI" frameborder="0"></iframe>
<p><br />
</p>Fri, 04 Apr 2014 00:00:00 -0600{E3BB2104-4C38-45F3-8779-73B643C4B621}https://10.40.239.128/blogs/2014/04/firefighter-goes-cold-turkey-on-sodas-and-energy-drinks/Firefighter Goes &#39;Cold Turkey&#39; on Sodas and Energy Drinks<p>As I write this post I am now 15 days into the 100 day challenge. I thought I would give everybody a little progress report and some struggles I have had starting up.</p>
<p>So I have lost over 11 pounds since starting, and I am still really excited and motivated about the Heart Healthy Challenge. I have had great support from my friends, family and co-workers. Thanks everyone for your encouragement and interest in learning about the program. My hope is to be able to get others thinking about their health and fitness, and try to be a resource for those that need some help (just like I do).</p>
<p>First things first. When I started the challenge I made a commitment to myself to cut out all soda and energy drinks. <strong>Going cold turkey on Mt. Dew and Monster/Rockstar's has probably been the hardest thing to do so far.</strong>&nbsp;Fifteen days and counting of being "Liquid Sugar" free! But I'm not going to lie, I still crave them.</p>
<p>Eating a Heart Healthy diet in a lot of aspects hasn't been as hard as I thought it would. <strong>I still struggle with those darn green veggie things</strong>. Anyone who has known me for any length of time understands my great dislike of most vegetables. I am learning that it is easier to eat them if I can hide them in other foods such as adding spinach into a fruit smoothie. I also have noticed that the way I shop at the grocery store has changed. Looking at labels and seeing what actual ingredients are in the foods that I eat has been insightful. And also seeing the horrible things I used to eat in the past is very scary.</p>
<p>Another change I realized very fast was the need to preplan daily meals and give myself extra preparation time. Being a busy person it has always been a lot faster and more convenient to eat out or go through a drive thru than to actually cook healthy meals. Learning what my healthy daily calorie intake should be and sticking to that number has been fine. Even cutting my calories has not made me feel hungry or be out of energy at all.</p>
<p>One issue I am having is problems with my feet while doing exercise. Having chronic problems with pain in both feet, as well as shin splints, makes walking or jogging very hard as well as being very discouraging. Looking at alternatives like biking or cardio exercises without putting extra strain on my feet will now have to suffice for now.</p>
<p><strong>I think one of the reasons I am so optimistic about this program is that it isn't a "gimmick" diet</strong>. I have tried several fad diets over the years and have had really good, although temporary results.&nbsp; Being able to lose vast amounts of weight in a short period of time is great, until you get off the diet and gain back all of the weight you have lost and gain a few more extra pounds than when you began. This program is really about a lifestyle change, no glitz, no glamour and no gimmicks. Simply put, it is just about going back to the basics and being smarter about choices I make in my life.</p>
<p>I hope all of my fellow competitors are doing great with the program and are having similar results and progress! Keep going strong everyone!</p>Fri, 04 Apr 2014 00:00:00 -0600{14481C94-463C-48B1-A1BE-144A0273B3EF}https://10.40.239.128/blogs/2014/04/inaugural-my-heart-challenge-play-at-home-edition-launches/Inaugural &#39;My Heart Challenge: Play at Home Edition&#39; Launches<p class="p1">The Play at Home version is a new element of the larger My Heart Challenge, which this year features 15 firefighters from seven fire departments in Salt Lake County. The 25 contestants will be working to make the same heart-healthy changes our 15 firefighters are making - which means eating healthier foods, exercising more, and tracking everything they are doing so they can achieve success.</p>
<p class="p2">Here are a few of the reasons these 25 people signed up to compete in this year's inaugural Play at Home Edition of the My Heart Challenge.&nbsp;</p>
<p class="p2">"I cannot walk up 15 stairs at work without losing my breath," writes one of the Play at Home contestants. "I can't fit in the rides at Lagoon and I want to be around to see my grandchildren grow up."</p>
<p class="p2">Another contestant writes, "I want to set a great example for my children and little sister. I was a swimmer in high school but never really learned how to be healthy. I want my kids to grow up with a health mom and not have to learn how to be healthy when they are my age; it's much harder to make changes later in life."</p>
<p class="p2">"I am a young father and I want to be healthy for my kids," writes another contestant. "I want to learn how to set a good example for them and I feel like this Challenge is a great opportunity to learn and change before I have real health and heart problems."&nbsp;</p>
<p class="p2">Each week, the 25 contestants will report on the number of days they tracked their steps and healthy meals, along with their current weight. Participants are also invited to join a 30-minute webcast on April 10 from 10:30-11 am, featuring TOSH dietitian Kary Woodruff and two firefighters talking about grocery shopping and eating on the run. A Facebook chat will also be held on Wednesday, April 30 from 10:30-11:30 am, discussing nutrition and exercise. The public is welcome to join in the discussions as well.&nbsp;</p>
<p class="p2">During the week of June 2-6, the Play at Home contestants will submit their final reports and check in at one of the Intermountain Heart Institute Cardiology Clinics for a final weigh-in. Points will then be tallied and the grand prize winner will be announced mid-June and invited to attend the 2014 My Heart Challenge Awards Ceremony on June 25, 2014 at Intermountain Medical Center to be recognized for their efforts to make heart-healthy changes at home - right alongside the 15 firefighters.&nbsp;</p>
<p class="p2">Everyone is invited to follow along and make little changes that will help improve their own heart health. Follow the blog for regular exercise and nutrition tips, along with updates on how the firefighters and Play at Home contestants are doing throughout the challenge.&nbsp;</p>
<p class="p2">----------------------------------------------------</p>
<p class="p2"><em>The winner of the Play at Home Edition will receive a Hurom Slow Juicer HU-100, courtesy of Kitchen Kneads in Ogden and West Jordan. The 2014 My Heart Challenge is sponsored by the Intermountain Medical Center Heart Institute, Fox 13, and Select Health.&nbsp;</em></p>Tue, 01 Apr 2014 00:00:00 -0600{1C309B4A-1F7F-4360-90F4-5A594EED322C}https://10.40.239.128/blogs/2014/03/tips-for-nutrition-success/Tips for Nutrition Success: The My Heart Challenge Play at Home Edition<strong>Track your nutrition and your exercise</strong>&nbsp;&nbsp;There are numerous forms of tracking your nutrition and exercise. You can choose to track with pen &amp; paper, such as with the Habit Tracker, and/or electronically with websites such as <a href="http://www.myfitnesspal.com/" target="_blank">myfitnesspal.com</a> &amp; <a href="http://www.livestrong.com/" target="_blank">livestrong.com</a>. Either way is fine, whichever you&rsquo;re most likely to utilize!<br />
<br />
<em>Keep in mind the tracking websites also have corresponding apps which can make tracking on the go much easier.</em><br />
<br />
<strong>Track everything.</strong> &nbsp;It doesn&rsquo;t do us any good if we just track the healthy foods we eat and exclude some of our less-healthy snacks. Everything that we eat and drink (other than water) has to go into the tracker!<br />
<br />
Speaking of tracking everything, we need to <strong>know correct portion sizes </strong>to make sure we&rsquo;re capturing everything. It&rsquo;s hard to look at a bowl of pasta and estimate how much it is &ndash; if you track it as one cup, but really it is 2 cups, that will really change your information. So get used to measuring things out, it makes a significant difference.&nbsp;<br />
<br />
<strong>Don&rsquo;t wait until the end of the day to track everything</strong>. We just aren&rsquo;t able to remember everything &ndash; we may remember our meals, but we tend to forget some of the add-ons, snacks, drinks, handful of M&amp;M&rsquo;s, etc. So check in with the tracker throughout the day<br />
<br />
<strong>Make exercise part of your routine!</strong> Meagan Kline from the Intermountain Medical Center Heart Institute will talk more about exercise, but I always recommend individuals schedule it into their time &ndash; we&rsquo;re much more likely to do it if it&rsquo;s on our schedule!<br />
<br />
<strong>Meal plan!</strong> This is one of the most crucial steps towards achieving our goals. We can want to eat healthy, but if we&rsquo;re not planning for it, it won&rsquo;t happen. Here are some meal planning tips:<br />
<br />
<ol>
<li>Plan out all, or at least some, of your meals for the week. &nbsp;If you know you&rsquo;ll have some busy nights, plan to make extra for leftovers on the other nights so you already have dinner planned when you have less time to cook.</li>
<li>Use recipes from healthy websites such as eatingwell.com for ideas for healthy meals. &nbsp;Eatingwell.com also has lots of delicious 20 minutes or less recipe ideas &ndash; yes, eating healthfully can also be quick and easy! We just have to make sure we plan for it and have the ingredients on hand.</li>
<li>Have a grocery list when you go to the store! This helps manage our grocery bills as well as make grocery shopping more efficient.</li>
<li>Part of your grocery list should include good, healthy staples we have on hand including healthy snacks. &nbsp;Ideas can include but are not limited to:
<ul>
<li>Greek yogurt</li>
<li>Fresh fruit</li>
<li>Fresh veggies</li>
<li>Hummus</li>
<li>Low-fat string cheese</li>
<li>Nuts/seeds</li>
<li>Low-fat cottage cheese</li>
<li>High fiber granola bars (such as Kashi Granola Bars)</li>
<li>Dried fruit (no sugar added)</li>
<li>Peanut butter/almond butter</li>
</ul>
</li>
</ol>
<strong>Avoid going more than 4-5 hours without eating.</strong>
<p> &nbsp;Break up long periods of time in between meals with healthy snacks. What is a healthy snack? 100 &ndash; 200 calories, and ideally combines some carbohydrates for energy (fruits, vegetables, whole grains) and some protein (nuts, seeds, whole grains, low-fat/nonfat such as yogurt and string cheese, hummus). See above for ideas you can mix and match.</p>
<strong>Spread your calories evenly throughout the day.&nbsp;</strong>The typical American skips breakfast or eats very little, often will eat lunch on the run, and then sits down to a large dinner. At the very least, try to avoid eating more calories in the evening. Getting a good breakfast and moderate lunch can help avoid over-eating in the evening<strong><br />
</strong><br />
Speaking of which&hellip; &nbsp;<strong>Eat Breakfast!</strong>&nbsp;Breakfast really is an important meal and can help prevent us from overeating later in the day. &nbsp;It is also a great opportunity to get important nutrients we need for the day, such as whole grains, fruits &amp; vegetables, and lean protein (egg whites, low-fat/nonfat dairy, nut butters, etc).<br />
<br />
<strong>Use the plate method for meal planning.</strong> &nbsp;This means aiming to have all of your meals be comprised of:<br />
<ul>
<li>&frac12; Vegetables and fruits</li>
<li>&frac14; whole grains &amp; starchy vegetables (sweet potatoes, potatoes, winter squashes, peas, corn)</li>
<li>&frac14; lean protein - This includes turkey/chicken white meat, fish, nuts/seeds, beans/legumes, low-fat/nonfat dairy, pork tenderloin, 90-95% lean beef</li>
</ul>
<p>Finally, refer to the <a href="http://bit.ly/MyHeartChallenge" target="_blank">My Heart Challenge blog</a> &ndash; there are weekly nutrition tips and blogs about how to continue to improve your heart health. Keep checking in to see what has been added!</p>Fri, 28 Mar 2014 00:00:00 -0600{6813D86D-B259-42E8-9525-19E5ED71936B}https://10.40.239.128/blogs/2014/03/find-the-heart-healthy-menu-item-at-restaurant/Find the heart healthy menu item when dining out<p>You are out to dinner at a restaurant you have never been to. You open the menu and see dozens of options. Which food item do you select?</p>
<p>a) The lasagna, of course &ndash; you haven&rsquo;t eaten for hours and you are starving, so that sounds the most satisfying. Of course, that also means you end up eating 3 pieces of bread while you wait.</p>
<p>b) You look at the menu and decide the chicken caesar salad sounds the healthiest. You then decide to order the chocolate cake for dessert to reward yourself for being good</p>
c) The grilled pork tenderloin with roasted vegetables &ndash; you had looked at the menu ahead of time and saw the deceptively high calories in the chicken caesar salad (900 calories?!), but realized the pork tenderloin was a more reasonable 600 calories. &nbsp;You had a little snack before you went so you avoided the temptation of the bread, and you had some fresh fruit for dessert<br />
<br />
The answer is c. &nbsp;<strong>Always know before you go!</strong>
<p>If you are going out to eat, take five minutes to look at the menu ahead of time and investigate what will be the healthiest and most satisfying choice for you. Most restaurants post their menu online, so a quick web search can help you identify the healthiest option.&nbsp;</p>
<p><strong>Don&rsquo;t arrive overly hungry</strong> &ndash; you are much more likely to overeat! &nbsp;And always ask for fresh fruit, it may not be listed on the menu but often times restaurants can provide this as a dessert option if requested.</p>Wed, 26 Mar 2014 00:00:00 -0600{A38236F5-493C-4822-955C-B0E863C42E56}https://10.40.239.128/blogs/2014/03/firefighters-biggest-challenge-in-the-my-heart-challenge/Firefighters&#39; biggest challenge in the My Heart Challenge<p>A weekly report is submitted by the 15 firefighters each Monday, detailing their heart-healthy behaviors from the week. They report on number of minutes spent exercising (both cardio and strength training), the number of days they ate a heart-healthy diet and their current weight. But each contestant is also asked to share a short response to a very simple question.&nbsp;</p>
<p><strong>The most difficult behavior modification I have made so far has been...</strong></p>
<p>"Not wavering from the diet, and not going out to eat with my crew at work. Also, finding motiviation to exercise during a busy day at work. Equally tough." <strong><em>- Kevin Platt, Firefighter/Paramedic, Sandy City Fire Department</em></strong></p>
<p>"Cutting sugar and diet soda." <em><strong>- Scott White, Captain, Murray City Fire Department</strong></em></p>
<p>"Going cold turkey on Mountain Dew and energy drinks." <strong><em>- David Larsen, Firefighter, South Salt Lake Fire Department</em></strong></p>
<p>"I am trying very hard to limit my sugar intake. I still find that in the afternoon I get a craving for something sweet." <em><strong>- Karl Steadman, Battalion Chief, Salt Lake City Fire Department</strong></em></p>
<p>"When I look at everything I am eating - including salt, spices, drinks, etc. - it all adds up! It's an amazing amount of calories, sodium, fat, etc. I didn't may much attention to this earlier, but now I do. It may take a little more time out of my day, but I know it will add time to my life and life-style." <em><strong>- Sharee Rosqvist, Firefighter/Paramedic, West Jordan Fire Department</strong></em></p>
<p>"Trying to eat three meals a day and not skip breakfast when I get busy at work or at home. Not perfect at this, but getting better at it." <strong><em>-&nbsp;</em></strong><em><strong>Bruce Cline, Fire Chief, Sandy City Fire Department</strong></em></p>
<p>"Eating. I LOVE cookies and I haven't had one since starting. I would like to say strength exercise, but I haven't mastered that one yet." <strong><em>- Chris Kinzel, Captain, West Jordan Fire Department</em></strong></p>
<p>"Eating out and watching caloric intake, as well as strength training with bad/rehabbing shoulder." <strong><em>- Gil Rodriguez, Fire Chief, Murray City Fire Department</em></strong></p>
<p>"I think the biggest challenge for me is keeping healthy foods in my house. I like eating this way but it is expensive and not always possible due to budget constraints." <em><strong>- Todd Caldwell, Battalion Chief, Unified Fire Authority</strong></em></p>
<p>"Changing eating habits." <em><strong>- Fenton Quinn, Firefighter/Engineer, Unified Fire Authority</strong></em></p>
<p>"Having to deal with my sweet tooth. Plus, I had a cheat day to satisfy my desire to eat <em>good</em> food. The diet is a lot of the same foods. I am going to have to find new things to eat." <strong><em>- Jeff Paul, Firefighter/Engineer, West Jordan Fire Department</em></strong></p>
<p>"Adding more veggies, also have a meatless day. It's kind of hard to change when I've always built my meals around the meat." <em><strong>- Mary Lindsay-Vonk, Engineer/Paramedic, West Valley City Fire Department</strong></em></p>
<p>"Having energy to continue to do cardio workouts. I get bored easily with running, but will try and power through. Meals have been getting easier and easier, and I have found some healthier foods that I enjoy. Of the one day I did not have a heart-healthy diet day, I ate really healthy all day, then went to the movies and had popcorn. I still stayed under my calories, but it still wasn't the best for me." <strong><em>- John Gulley, Firefighter, Unified Fire Authority</em></strong></p>
<p>After participating in a <a href="http://youtu.be/1J-eCZY9ocQ" target="_blank">media story</a> with Fox13 News, John Gulley was interviewed for a short video asking what his biggest challenge has been so far. Watch what he had to say about it:</p>
<iframe width="853" height="480" src="//www.youtube.com/embed/_AcolTlpyHw" frameborder="0"></iframe>Tue, 25 Mar 2014 00:00:00 -0600{F26A9C58-E45A-49E7-906A-7F6687039A2A}https://10.40.239.128/blogs/2014/03/the-right-way-to-do-squats/The right way to do squats<p>The best way to start squats is to train your muscles to know the proper position of a squat. The best way to do this is with a chair. As I demonstrate in the video below, stand in front of a stationary chair and practice sitting back into the chair. As you will see, my movement is back, not down.&nbsp;</p>
<p>As you progress you won't need to use the chair. Simply stand in a room away from any furniture and move backwards like you are going to sit in an imaginary chair. It's important to keep your knees from moving in front of your toes, which may cause some lower back injury if done improperly.&nbsp;</p>
<p>Once you have the exercise down, incorporate it into your workout (or start a new workout routine). Build your way up to three sets of 20 squats with a 30-second break in between each set.&nbsp;</p>
<iframe width="853" height="480" src="//www.youtube.com/embed/HBOxMpmpQcQ" frameborder="0"></iframe>Mon, 24 Mar 2014 00:00:00 -0600{0E74EF28-38BC-43DE-A821-292759ED8B2A}https://10.40.239.128/blogs/2014/03/secret-of-success-building-a-great-support-system/Secret of Success: Building a great support system<p><strong>Group Exercise<br />
</strong>Studies have shown that building a social network into your exercise program actually increases attendance. Whether that means attending the 9 am spin class each Monday or having a workout-buddy to walk with daily &ndash; partner up and you&rsquo;re less likely to cancel.&nbsp;</p>
<p><strong>Family<br />
</strong>Support at home can make a huge difference in your success. This may include cooking healthy meals together at home, walking with a spouse after dinner or playing outdoors with your children more often. </p>
<p><strong>Co-workers<br />
</strong>Include those you work with in your goal setting and allow them to keep you accountable. This will certainly be the case with our firefighters competing in the My Heart Challenge &ndash; 48 hours together allows for unlimited support from co-workers.&nbsp;</p>
<p><strong>Let others know about your goals<br />
</strong>Social media can be a great way to track, update and include others in your goals and progress. Public exposure increases the likelihood that you&rsquo;ll stick to the lifestyle change you need.&nbsp;</p>
<p><strong>Tracking<br />
</strong>This can be a very effective method of motivation if used <em>consistently</em>. Track those variables that are most important to you. Individual factors can add up quickly, so don&rsquo;t let yourself become overwhelmed. Tracking can happen in a notebook, on an app or even an old-school method: a calendar. The difference happens when you can see the progress you&rsquo;ve made and it can serve as a motivator to continue in your progress.</p>Fri, 21 Mar 2014 00:00:00 -0600{D027B236-647E-4A6E-98A0-DB5A19061487}https://10.40.239.128/blogs/2014/03/the-art-and-science-of-weight-loss/The Art and Science of Weight Loss<p>Unhealthy dietary intake and inadequate physical activity are the foundation of many chronic diseases that plague the human race. These behaviors have their roots firmly planted in a society that has increasingly engineered physical activity out of our lives, and made available food that is high in fat and calories. The combination has turned deadly for our society. Low aerobic fitness, a consequence of sedentary lifestyle, is associated with a 56% increased risk of heart disease<sup>1</sup>, and a 35% increased risk of Alzheimer&rsquo;s dementia<sup>2</sup>, compared to individuals with high cardiorespiratory fitness. It&rsquo;s estimated that physical inactivity accounts for 1 in 10 deaths worldwide; and if physical inactivity could be reduced by just 25%, 1.3 million deaths could be averted each year.<sup>3</sup> Likewise, diets high in saturated fat are associated with higher rates of heart disease.<sup>4, 5</sup></p>
<p>With such compelling evidence regarding the risk of unhealthy dietary intake and inadequate physical activity, along with the benefits of meeting recommended guidelines for diet and activity, why does our society still struggle with these behaviors and the subsequent consequences? The answer to this question is long and complicated. In the simplest of terms it can be explained from a socio-ecologic perspective with firm biological underpinnings. Our genetics certainly play a pivotal role in behavior and behavioral consequences. Yet equally important is where we live and with whom we live. The latter concept has become increasingly well-developed in the past decade, where we have come to understand that people who associate with healthy friends (who eat better and move more), are in fact more likely to be healthy themselves.<sup>6</sup> The converse also holds true, such that people who are obese tend to have obese friends.<sup>7</sup></p>
<p>These findings suggest that efforts to reverse trends in obesity, and other chronic diseases resulting from diet and inactivity, need to address not only biology, but also environment, social networks, and ultimately behaviors. </p>
<p>Behavior change is one of those 14 letter phrases that is so easy to say, yet so hard to do. Ask anyone who has tried to quit smoking or lose weight, and they will most likely tell you how hard it was. There are many components that play a role in successful behavior change, such as knowledge, attitudes, beliefs, and barriers. What&rsquo;s important to note here is knowledge alone is not enough! A recent meta-analysis by Rose, et al., entitled, <em>Physician weight loss advice and patient weight loss behavior change,</em><sup>8</sup><em>&nbsp; </em>found that physician counseling regarding weight loss results in clinically significant weight loss. Studies in the meta-analysis generally included and assessed the impact of a behavioral component, such as motivational interviewing, use of the 5As, and communication skills of the physician. It also bears mentioning that the U.S. Preventive Services Task Force (USPSTF) recommends intensive lifestyle intervention for obese individuals seeking weight loss.<sup>9</sup> </p>
<p>In this issue, Dr. Janet Rankin, has nicely summarized the literature on diet and exercise interventions aimed at improving body composition in individuals with obesity. In it, she reports that the optimal diet to achieve a leaner physique is moderate in total calories, low in fat, and higher in lean protein. In addition, she concludes that exercise alone is insufficient to result in significant weight loss, but in combination with the aforementioned dietary changes, 250 minutes/week of moderate intensity aerobic exercise and twice-weekly resistance training can result in clinically significant changes in body composition.<sup>10</sup></p>
<p>Given the overwhelming volume of information on diet, this summary is a valuable source of information for clinicians who, come January 2, will be face to face with patients who seek their counsel on achieving current New Year&rsquo;s resolutions. For those clinic visits to be meaningful for patients, clinicians will need to: 1) integrate content knowledge imparted by Dr. Rankin&rsquo;s paper; 2) incorporate behavior change strategies including prioritization and readiness for change; and 3) develop an understanding of the resources and barriers that impact the patients&rsquo; ability to change. </p>
<p>The 5As have emerged as an effective strategy for approaching behavior change. This model is endorsed by the Centers for Medicare and Medicaid Services and the USPSTF.<sup>9</sup> The 5As do not represent rigid linear steps, but rather help shape an ongoing conversation that promotes successful behavior change; Dr. Rankin advocates for this approach as well. Primary care providers should consider this as a structure to guide conversations with patients. Using the structure provided in the article, &ldquo;Assess&rdquo; includes assessment of lifestyle and health risks, behaviors and concerns. Next comes &ldquo;Advise&rdquo; the patient on personal health risks in addition to evidence-based interventions and behaviors. The third step is &ldquo;Agree,&rdquo; which is critical in helping the patient focus on 1 to 3 specific goals based on personal preferences and readiness to change. &ldquo;Assist&rdquo; includes supporting the patient by making an action plan promoting accountability and identifying resources. This is the place for SMART goals &ndash; <strong><span style="text-decoration: underline;">S</span></strong>pecific, <strong><span style="text-decoration: underline;">M</span></strong>easurable, <strong><span style="text-decoration: underline;">A</span></strong>ttainable, <strong><span style="text-decoration: underline;">R</span></strong>ealistic, and <strong><span style="text-decoration: underline;">T</span></strong>ime-based. The fifth A is &ldquo;Arrange.&rdquo; This may include arranging a referral to a personal trainer or physical therapist, if needed. It may be to arrange follow-up to adjust goals, clarify the treatment plan, and assess progress. Changes in healthcare coverage have made this final A harder to implement. Patients on high deductible health plans may be reluctant to pay out&ndash;of-pocket for follow-up visits. However, it&rsquo;s important to keep in mind that provisions of the Affordable Care Act also provide coverage for Medical Nutrition Therapy (MNT) with a dietitian, and intensive lifestyle counseling for Medicare enrollees with a primary care provider. It&rsquo;s beyond the scope of this article to delve into the details, but providers should make themselves aware of federal and local coverage for these services. </p>
<p>Finally, it&rsquo;s worth mentioning that even minimal weight loss can have a profound impact on health outcomes. One does not need to lose 50-100 lbs to realize significant reduction in health risk. For example, the Diabetes Prevention Program found that even a 7% weight loss (17.5 lbs for a 250 lb person) can significantly reduce the likelihood of developing diabetes.<sup>11</sup> Obstructive sleep apnea (OSA) is another condition associated with obesity. For every 1% decrease in weight, there is a 3% decline in the risk of OSA.<sup>12</sup> Osteoarthritis is one of the most prevalent chronic medical conditions.&nbsp; Weight loss of only 15 pounds can cut knee pain in half for overweight individuals with arthritis.<sup>13</sup></p>
<p>Primary care physicians are a trusted source of information for their patients. It behooves us to understand what constitutes effective prevention and treatment of chronic disease. The foundation for many lies in unhealthy diets and inadequate physical activity. Armed with this knowledge and applying sound behavior change principles, we can help our patients achieve their goals and improve their health.</p>
<br />
<p style="line-height: 200%;"><strong><span style="text-decoration: underline;">References:</span></strong></p>
<ol>
<li>Kodama et al. Cardiorespiratory Fitness as a Quantitative Predictor of All-Cause Mortality and Cardiovascular Events in Healthy Men and Women: A Meta-analysis. JAMA The Journal of the American Medical Association, 2009; 301 (19): 2024.</li>
<li>Willis BL, Gao A, Leonard D, DeFina LF, Berry JD. Midlife Fitness and the Development of Chronic Conditions in Later Life. Arch Intern Med. 2012;172(17):1333-1340.</li>
<li>Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012 Jul 21;380(9838):219-29.</li>
<li>Hu FB, Stampfer MJ, Manson JE, et al. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med 1997;337:1491&ndash;9.</li>
<li>Jakobsen MU, Overvad K, Dyerberg I, Schroll M, Heitmann BL. Dietary Fat and Risk of Coronary Heart Disease: Possible Effect Modification by Gender and Age. Am. J. Epidemiol. (2004) 160 (2): 141-149.</li>
<li>Sawka KJ, McCormack GR, Nettel-Aguirre A, Hawe P, Doyle-Baker PK. Friendship networks and physical activity and sedentary behavior among youth: a systematized review. Int J Behav Nutr Phys Act. 2013 Dec 1;10(1):130.</li>
<li>Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007 Jul 26;357(4):370-9.</li>
<li>Rose SA, Poynter PS, Anderson JW, Noar SM, Conigliaro I. Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data. International Journal of Obesity (2013) 37, 118 &ndash; 128.</li>
<li>U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2012;157:373-378. http://www.uspreventiveservicestaskforce.org/uspstf/uspsobes.htm. Accessed December 17, 2013</li>
<li>Rankin JW. Effective Diet and Exercise Interventions to Improve Body Composition in Obese Individuals. Am J Lifestyle Med</li>
<li>Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England journal of medicine. 2002 Feb 7;346(6):393-403.</li>
<li>Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015- 21.</li>
<li>Bartlett SJ, Haaz S, Wrobleski P et al. Small weight losses can yield significant improvements in knee OA symptoms. Arthritis &amp;. Rheumatism 2004; 50[9 (S)], S658.</li>
</ol>
<p>&nbsp;</p>Wed, 19 Mar 2014 00:00:00 -0600